Autism Spectrum

Disorders (ASD)
Cara Kimberg, M.S.
 What is Autism?
 Four ways to “define” autism
 DSM-IV
 Parents with a child with autism

 Individuals with autism

 What we know (i.e. stereotypes of

autism)
 Let’s take a look at each one to get a
more comprehensive idea of this
disorder
 DSM-IV criteria
 First, important to note that autism is a
spectrum disorder characterized by:
 Impairments in social interaction
 Impairments in communication

 Presence of restricted, repetitive behaviors

(RRBs)
 Spectrum = variability within and across
these areas
 1 in 150 children diagnosed with autism
includes the entire spectrum
 DSM-IV criteria
(continued)
 Umbrella term is really Pervasive
Developmental Disorders (PDD)
 5 different subtypes of PDD
 Autistic Disorder Autism
 Asperger’s Disorder Spectrum
 PDD-NOS Disorders
 Rhett’s Disorder

 Childhood Disintegrative Disorder

Rhett’s Disorder (299.80)
 (A) All of the following:

 apparently normal prenatal and perinatal development

 apparently normal psychomotor development through the
first 5 months after birth
 normal head circumference at birth
 (B) Onset of all of the following after the period of normal
development:

 deceleration of head growth between ages 5 and 48 months

 loss of previously acquired purposeful hand skills between
ages 5 and 30 months with the subsequent development of
stereotyped hand movements (e.g., hand-wringing or hand
washing)
 loss of social engagement early in the course (although often
social interaction develops later)
 appearance of poorly coordinated gait or trunk movements
 severely impaired expressive and receptive language
development with severe psychomotor retardation
 Facts about Rhett’s
Disorder
 Complex neurological disorder
 Genetic in origin
 Primarily in girls
 Present at birth but more apparent during second
year
 Second most common cause of severe learning
disability in girls
 1:10,000 to 1:23, 000 diagnosed
 Period of temporary regression including loss of
communication skills, and purposeful hand
movements
Childhood Disintegrative Disorder
(299.10)
(A) Apparently normal development for at least the first 2 years

after birth as manifested by the presence of age-appropriate
verbal and nonverbal communication, social relationships, play,
and adaptive behavior.
 (B) Clinically significant loss of previously acquired skills
(before age 10 years) in at least two of the following areas:
 expressive or receptive language
 social skills or adaptive behavior
 bowel or bladder control
 play
 motor skills
 (C) Abnormalities of functioning in at least two of the following
areas:
 qualitative impairment in social interaction (e.g., impairment in
nonverbal behaviors, failure to develop peer relationships, lack
of social or emotional reciprocity)
 qualitative impairments in communication (e.g., delay or lack
of spoken language, inability to initiate or sustain a
conversation, stereotyped and repetitive use of language, lack
of varied make-believe play)
 restricted, repetitive, and stereotyped patterns of behavior,
interests, and activities, including motor stereotypies and
mannerisms
 (D) The disturbance is not better accounted for by another
specific Pervasive Developmental Disorder or by Schizophrenia.
 Facts about Childhood
Disintegrative Disorder
 Child regresses from age 2-10
(debated) in terms of language skills,
social behavior, and all developmental
motor skills
 Can occur abruptly or over a longer
period of time
 Sometimes child is aware of their loss
of skills
 No cure
 Autistic Disorder (299.0)

 (A) total of six (or more) items from (1), (2), and (3),
with at least two from (1), and one each from (2) and
(3):

1)qualitative impairment in social interaction, as

manifested by at least two of the following:
 (a) marked impairment in the use of multiple nonverbal

behaviors such as eye-to-eye gaze, facial expression,

body postures, and gestures to regulate social
interaction
 (b) failure to develop peer relationships appropriate to

developmental level
 (c) a lack of spontaneous seeking to share enjoyment,

interests, or achievements with other people (e.g., by a

lack of showing, bringing, or pointing out objects of
interest)
 (d) lack of social or emotional reciprocity
 Autistic Disorder
(2) qualitative impairments in communication as
manifested by at least one of the following:

 (a) delay in, or total lack of, the development of spoken

language (not accompanied by an attempt to
compensate through alternative modes of
communication such as gestures or mime)

 (b) in individuals with adequate speech, marked

impairment in the ability to initiate or sustain a
conversation with others

 (c) stereotyped and repetitive use of language or

idiosyncratic language

 (d) lack of varied, spontaneous make-believe play or

social imitative play appropriate to developmental level
 Autistic Disorder
(3)restricted repetitive and stereotyped patterns of
behavior, interests, and activities, as manifested by
at least one of the following:

 (a) encompassing preoccupation with one or more

stereotyped patterns of interest that is abnormal
either in intensity or focus

 (b) apparently inflexible adherence to specific,

nonfunctional routines or rituals

 (c) stereotyped and repetitive motor mannerisms

(e.g., hand or finger flapping or twisting, or
complex whole-body movements)

 (d) persistent preoccupation with parts of objects

 Autistic Disorder
 (B) Delays or abnormal functioning in
at least one of the following areas,
with onset prior to age 3 years: (1)
social interaction, (2) language as
used in social communication, or (3)
symbolic or imaginative play.

 (C) The disturbance is not better

accounted for by Rett's Disorder or
Childhood Disintegrative Disorder.
 Asperger’s Disorder
 (A) Qualitative(299.80)
impairment in social interaction, as
manifested by at least two of the following:
 marked impairment in the use of multiple nonverbal
behaviors such as eye-to-eye gaze, facial expression, body
postures, and gestures to regulate social interaction
 failure to develop peer relationships appropriate to
developmental level
 a lack of spontaneous seeking to share enjoyment, interests,
or achievements with other people (e.g., by a lack of showing,
bringing, or pointing out objects of interest to other people)
 lack of social or emotional reciprocity.
 (B) Restricted repetitive and stereotyped patterns
of behavior, interests, and activities, as manifested
by at least one of the following:
 encompassing preoccupation with one or more stereotyped
and restricted patterns of interest that is abnormal either in
intensity or focus
 apparently inflexible adherence to specific, non-functional
routines or rituals
 stereotyped and repetitive motor mannerisms (e.g., hand or
finger flapping or twisting, or complex whole-body
movements)
 persistent preoccupation with parts of objects
 Asperger’s Disorder
 (C) The disturbance causes clinically significant
impairment in social, occupational, or other
important areas of functioning.

 (D) There is no clinically significant general delay

in language (e.g., single words used by age 2 years,
communicative phrases used by age 3 years)

 (E) There is no clinically significant delay in

cognitive development or in the development of
age-appropriate self-help skills, adaptive behavior
(other than in social interaction), and curiosity
about the environment in childhood.

 (F) Criteria are not met for another specific

Pervasive Developmental Disorder or
Schizophrenia.
 Pervasive Developmental
Disorder-NOS (299.80)
 This category should be used when there is a severe
and pervasive impairment in the development of
reciprocal social interaction or verbal and nonverbal
communication skills, or when stereotyped behavior,
interests, and activities are present, but the criteria
are not met for a specific Pervasive Developmental
Disorder, Schizophrenia, Schizotypal Personality
Disorder, or Avoidant Personality Disorder. For
example, this category includes atypical autism ---
presentations that do not meet the criteria for
Autistic Disorder because of late age of onset,
atypical symptomatology, or subthreshold
symptomatology, or all of these.
 Parents of children with
ASD
 http://www.autismspeaks.org/sponso
redevents/autism_every_day.php
 Impact on the family
 Social
 Financial

 Everyday routines

 Variable experiences based on an

individual child and his/her
strengths and weaknesses
 Anecdotal Stories
(www.Autismspeaks. org)
 Individuals with Autism
 http://www.autismspeaks.org/video/index.
php
 How people with autism see the world
 Life of Adults with Autism
 Temple Grandin “Autism the way I see it”
 Different types of thinking in autism
 1.Visual thinking - Thinking in Pictures, like mine
2. Music and Math thinking
3. Verbal logic thinking
 Play to strengths to be most effective
 http://autisticsavant.blogspot.com/2007_0
5_27_archive.html
 Story from a Teenager

with ASD
“The characteristics of people with Asperger's are the perfect ones
to make obtaining friends difficult. Asperger's Syndrome is part of a
spectrum of autistic disorders, all linked by a level of non-
communication. At the lowest level, we have cases like my brother
Eric, a person trapped in a void where communication is only at the
most rudimentary level, about the level of a non-expressive two or
three year old. Then among several forms at the highest level, we
have Asperger's syndrome. Those with Asperger's often suffer from
a plethora of symptoms. The most prominent ones are difficulty with
reading people's body language, a singular interest in a subject or
several subjects (from my own life, I have one major interest in rock
music, compulsively looking for new reviews and obsessing over the
best quality of sound to listen to them), a slight monotone voice,
struggling with proper body distance, and a tendency to use a
vocabulary that is of a slightly higher sophistication than most
people would use such as when I employ words like vitriolic,
inundate, smorgasbord, plethora, paraphernalia, and others of that
variety. While obviously every person with the syndrome may not
experience each and every single trait, I have experienced all of
these symptoms to some degree. Couple that with a fairly shy
personality, a shyness that may or may not have anything to do with
Asperger's Syndrome, and I am often left feeling like everyone sees
me as being quiet and not worth talking to.”
 (Autismspeaks.org)
 Stereotypes about ASD
 Head banging
 Hand flapping
 Non-communicative
 Non-verbal
 “own world”
 How is Autism
Diagnosed?
 Autism Diagnostic Observation Schedule
(ADOS; Lord et al)
 Autism Diagnostic Interview-Revised (ADI-R;
Rutter et al)
 Social Communication Questionnaire (SCQ;
Rutter et al)
 Childhood Autism Rating Scale (CARS;
Schopler et al)
 Clinical judgment plays a HUGE role
 What are the dangers of this?
 Potential differential diagnoses (type of
language/communication disorder, OCD, anxiety
disorder)
 Benefits of Early
Diagnosis
 Treatment and intervention
effectiveness
 Skill acquisition
 exposure
 Types of
Treatments/Interventions
 Interpersonal Relationship
Intervnetions and Treatments
 Skill-Based Interventions and
Treatment
 Cognitive Interventions and Treatment
 Physiological/Biological/Neurological
Interventions and Treatment
 Other Interventions, Treatments and
Related Agents
 Interpersonal
Relationship
 Social-affective interpretation of ASD
 Need for people with ASD to express
attachments to others appropriately
 Seek to facilitate affect, attachment,
bonding, sense of relatedness
 Holding Therapy (not recommended)
 Developmental, Individual-Difference
Relationship Based Model (Floortime;
www.icdl.com)
 Skill-Based
 Most common methods used by schools
 Intent is to develop and support functional
demonstration of specific skills rather than
to facilitate bonding
 Target specific skills to teach to improve
functioning in specific areas
 Picture Exchange Communication System (PECS)
 Facilitated Communication (not recommended)
 Assistive Technology
 Applied Behavior Analysis (Scientifically Based
Practice)
 TEACCH
 Cognitive
 Teaching individuals with ASD to monitor
their own behavior and performance
 Shift control from others to the
individuals
 Connection between thoughts, feelings
and behavior
 Social Stories
 Social Decision Making Strategies

 LEAP (Scientifically Based Practice)

Physiological/Biological/Neur
ological
 Address the neurological dysfunctions or
problems thought to exist at the core of ASD
 Alter way in which neurological system
processes information, the manner in which
information is received, chemistry and
processes associated with sensations,
perceptions and emotions
 Irlen Lenses (limited support)
 Sensory integration (promising practice)
 Auditory Integration Training (limited support)
 Pharmacology (promising practice)
 Others
 Mercury: Vaccinations and Autism
(limited support)
 Gluten-Casein Intolerance (limited
support)
 Music therapy (limited support)
 Controversies with
Treatments
 Limited scientific support
 Treatments as a “cure”
 Decisions regarding financial
resources
 Where does research money go?
 Autism is all over the news
 Community Resources
 Center for Autism and Related
Disabilities